Symptom screening in detection of occupational solvent-related encephalopathy
Symptom screening in detection of occupational solvent-related encephalopathy
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DOI：
10.1007/s00420-008-0341-1
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发表时间：
2009-02-01
影响因子：
3
通讯作者：
Sainio, Markku
中科院分区：
文献类型：
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作者：
Kaukiainen, Ari;Akila, Ritva;Sainio, Markku
需要灵敏和易于应用的方法来早期检测与职业溶剂暴露相关的中枢神经系统不良反应。本研究评估症状筛查在实践中的作用。在芬兰对2,000名建筑工人进行了横断面问卷调查，包括油漆工和木匠。计算慢性溶剂性脑病（CSE）相关症状的评分。比较高分组（N = 28）与其他所有受试者对暴露和健康的反应。得分最高的受访者，无论他们的职业和接触，被邀请进行临床检查，以调查症状的病因。如果检查结果为疑似CSE，则进行多学科鉴别诊断随访程序，症状评分最高的应答者比评分较低的应答者更多地暴露于溶剂（P < 0.001），并且更经常报告医生诊断的疾病，特别是精神疾病（P < 0.001）。他们也消耗更多的酒精（P = 0.005），更经常失业或无法工作（P < 0.001）。在临床检查中，除了相当多的溶剂暴露史和临床神经学结果外，还经常发现睡眠障碍、躯体疾病、抑郁、失业和饮酒。进一步检查和诊断性随访证实了3例脑病。一个病例是CSE，一种职业病。其他两个脑病病例有多因素病因，包括solvent.Screening在积极的劳动力的认知功能障碍的症状，识别高度溶剂暴露的工人，也揭示了职业和非职业性脑病病例。鉴别诊断条件的评价是必不可少的检测CSE。提出了一个逐步模型。
Sensitive and easily applicable methods are needed for early detection of central nervous system adverse effects related to occupational solvent exposure. The present study evaluates how symptom screening works in practice.A cross-sectional questionnaire survey was conducted on 2,000 construction workers, including painters and carpenters, in Finland. Scores were calculated for symptoms relevant for chronic solvent encephalopathy (CSE). Responses on exposure and health were compared between subjects with high score (N = 28) and all other respondents. The respondents with the highest scores, regardless of their occupation and exposure, were invited for clinical examination to investigate the aetiologies of the symptoms. If the examination resulted in a suspicion of CSE, a multidisciplinary differential diagnostic follow-up procedure was performed.The respondents with highest symptom scores were more exposed to solvents than those with lower scores (P < 0.001) and reported more often physician-diagnosed diseases, especially psychiatric disorders (P < 0.001). They also consumed more alcohol (P = 0.005) and were more often unemployed or unable to work (P < 0.001). In the clinical examination, sleep disturbances, somatic disorders, depression, unemployment, and alcohol use were commonly found in addition to considerable solvent exposure history and clinical neurological findings. Further examinations and a diagnostic follow-up verified three cases of encephalopathy. One case was a CSE, an occupational disease. The other two encephalopathy cases had multifactorial aetiology including solvents.Screening in active workforce for symptoms of cognitive dysfunction identifies highly solvent-exposed workers and also reveals occupational and non-occupational cases of encephalopathy. Evaluation of differential diagnostic conditions is essential in the detection of CSE. A stepwise model is proposed.